Getting help early involves recognising psychosis at the earliest possible time and finding appropriate specialist treatment.
The initial episode of psychosis can be a particularly confusing and traumatic experience. The change in the person's behaviour causes concern and distress because no-one really understands what is happening. This lack of awareness often leads to delays seeking help. As a result, these treatable illnesses are left unrecognised and untreated. Even when help is sought, further delays may occur before the right diagnosis is made because recognition of these disorders can be difficult.
Often there is a long delay before treatment begins for the first episode of psychosis. The longer the illness is left untreated the greater the disruption to a person's family, friends, study and work. The way they feel about themselves can be affected, particularly if treatment is prolonged. Other problems may occur or intensify, such as unemployment, depression, substance abuse, breaking the law and causing injury to themselves. In addition, delays in treatment may lead to slower and less complete recovery. Disruption need not occur. If psychosis is detected early, many problems can be prevented.
Usually there are some changes in a person before the obvious symptoms of psychosis develop. These changes are called early signs and this phase just before the psychosis is called the prodrome. The early signs are vague and hardly noticeable. The important thing to look for is if these changes get worse or simply do not go away. Early signs vary from person to person. In the prodromal phase, there may be changes in the way some people describe their feelings, thoughts and perceptions. However, they have not started experiencing clear psychotic symptoms such as hallucinations, delusions or confused thinking.
A person may become:
suspicious
depressed
anxious
tense
irritable
angry
A person may experience :
mood swings
sleep disturbances
appetite changes
loss of energy or motivation
A person may feel :
their thoughts are speeded up or slowed down
things are somehow different
things around them seem changed
Often family and friends are the first to notice the changes.
Family and friends may notice when :
a person's behaviour changes
a person's studies or work deteriorate
a person becomes more withdrawn or isolated
a person is no longer interested in socialising
a person becomes less active
Families often sense that something is not quite right even though they don't
know exactly what the problem is. These behaviours might be a brief reaction
to stressful events like hassles at school or work or trouble with relationships.
On the other hand, they may be early warning signs of a developing psychosis.
It is important that these behaviours are checked out.
Copyright (1995) EPPIC & Department of Human Services
(Victoria)
Well over 1% of the population will develop a psychotic illness sometime in their lifetime. Young people (men age 16-25 and women 16-35) are at particularly high risk. The risk is further increased with positive family history of a similar condition, and illicit drug abuse (including cannabis). An individual at risk can have the first episode of psychosis triggered by even mild use of illicit drugs, excessive alcohol use, or stress. Individuals with all levels of intelligence and from all social backgrounds can be affected by psychosis.
Yes, there is effective treatment available. Research has shown that Early Intervention for Psychosis services have a significant positive effect for clients whilst in treatment. Early intensive treatment results in earlier psychotic and negative symptom remission, less psychosocial deterioration and increased treatment adherence.
Turner MA. Evaluation of Early Intervention for Psychosis Services in
New Zealand: What Works? Wellington, NZ: Health Research Council of New
Zealand; 2002.
Larsen TK, Friis S, Haahr U, Joa I, Johannessen JO, Melle I, et al. Early
detection and intervention in first-episode schizophrenia: a critical review.
Acta Psychiatrica Scandinavica 2001;103:323-34.
Malla AK, Norman R, Voruganti LP. Improving outcome in schizophrenia: the
case for early intervention. Canadian Medical Association Journal 1999;160:843-6.
When these prodromal or psychotic symptoms appear it is important that the young person gets help. A good place to start is with a local doctor, community health centre, or community mental health service. School counsellors might also be available. Remember these changes in behaviour may not be early signs, but it is a good idea to get them checked out.
If a psychotic disorder is developing the sooner the young person gets help the better. The earlier psychosis is recognised and treatment commences, the better the outlook.
A longer duration of untreated psychosis (the period from the onset of psychosis to the implementation of ‘adequate treatment’) has been shown to predict poor outcome. In addition, the illness process of psychosis is most actively severe in the early phase. The majority of deterioration occurs within the first five years.
Reference
Birchwood, M. (1998) Early intervention in psychosis. The critical period hypothesis. British Journal of Psychiatry Suppl;172(33):53-9.
Potential consequences of delaying assessment and treatment include:
slower and less complete recovery
poorer prognosis
increased risk of secondary morbidity
interference with psychological and social development
strain on relationships; loss of family and social supports
disruption of person's parenting skills (for those with children)
distress and increased psychological problems in the family
disruption of study and/or employment
substance abuse
criminal activities
unnecessary hospitalisation
loss of self-esteem and confidence
increased cost of management
self-harm